What’s the Deal with CBD Oil?
The cannabis-derived product is incredibly popular, but what are the risks and benefits for people with bleeding disorders?
Last October, a New York Times headline asked a question many people across the country have had on their minds: “Why Is CBD Everywhere?” CBD oil, scientifically known as cannabidiol oil, has been heavily marketed as a cure-all for everything from inflammation and chronic pain to anxiety and insomnia. For people with bleeding disorders, CBD oil may seem appealing to try. But what is it exactly, and how much evidence is there that it actually works?
What is CBD oil?
Cannabidiol (CBD) is one of several chemical compounds, called cannabinoids, found in the cannabis plant. Another cannabinoid is delta-9-tetrahydrocannabinol (THC), the compound in marijuana that makes you high.
How is CBD oil made?
CBD is extracted from the cannabis plant and added to oils, creams and balms, liquids for vaping, pills and even candies like mints and gummies.
How does CBD oil make you feel?
Unlike THC, CBD does not get you “stoned.” Some report that CBD’s effects include both physical and mental relaxation, reduced soreness and inflammation, and improved focus. However, some users say they don’t feel anything.
What’s the evidence that it works?
Little research has been done into the health effects of CBD. However, more studies are underway, and health agencies such as the National Institutes of Health and the World Health Organization agree more research is needed. In the US, just one prescription drug has been approved that contains CBD as its active ingredient: Epidiolex, which reduces seizures in people with two rare forms of epilepsy.
Is CBD safe?
Some studies indicate CBD—and other cannabinoids—may have an anticoagulant effect by suppressing production of blood platelets, which is an obvious concern for anyone with a bleeding disorder. Another issue is how CBD interacts with other medications, which is uncertain and needs more study.
More broadly, general safety is a gray area when it comes to CBD oil. Production of CBD oil products is unregulated, so it can be difficult to know exactly what you’re getting. The US Food and Drug Administration tested several brands of CBD oil and says that “many were found to not contain the levels of CBD they claimed to contain.” Other research has found some CBD products contained levels of THC that could cause intoxication. In an exhaustive report on CBD oil, Consumer Reports magazine says it may be safer to buy CBD in states where medical and recreational use of cannabis is legal, as standards are likely to be stricter in these locations. Another tip is to look for CBD from producers who post the results of third-party testing of their products.
Is CBD legal?
In most states, CBD is legal as long as it is extracted from the hemp variety of the cannabis plant and it contains no THC (the 2018 federal farm bill legalized cultivation of hemp). You can check the laws in your state at the website of the National Organization for the Reform of Marijuana Laws (NORML).
The bottom line.
CBD may help relieve pain, anxiety and insomnia, but it also may not. If you’re interested in using it, be sure to check with your healthcare team first so they can advise you on how to use it and monitor its effects.
SEVERE IMMUNE THROMBOCYTOPENIC PURPURA SECONDARY TO SYNTHETIC CANNABINOID USE
Case Presentation: 46 year old male with history of hypertension on losartan, gastroesophageal reflux disease on omeprazole and history of gout (not on medications) presents to his primary care provider for a new onset skin rash. Examination revealed a non-pruritic, petechial rash on his anterior chest and upper extremities that started 5 days ago. He denied any other prodromal symptoms of cough, sore throat, fever, myalgias or sick contact exposure. Laboratory evaluation revealed a platelet count of 5 x10(9)/L (normal range 150-350 x 10(9)/L). Hemoglobin, white blood cell count and renal function were within normal range. Liver enzymes were mildly elevated with aspartate aminotransferase at 104 U/L (8-43 U/L) and alanine aminotransferase at 154 U/L (7-45 U/L). Peripheral smear revealed no clumping of platelets or schistocytes. Given severe thrombocytopenia and petechial rash he was admitted to the hospital for further work up. Infectious work up including Hepatitis B and C, HIV, Epstein Barr Virus, Cytomegalovirus and SARS COVID 19 were negative. Autoimmune panel for vasculitis revealed weakly positive antinuclear antibody, but normal otherwise. He consumes 6 drinks of alcohol/week along with nightly use of cannabidiol (CBD) oil for sleep. Given progressive petechial rash and severe thrombocytopenia the diagnosis of severe Immune Thrombocytopenic Purpura (ITP) was considered and he was initiated on oral prednisone (1mg/kg/day) and Intravenous Immunoglobulin (IVIG) of 1g/kg/day. Given the critically low platelets, he also received a one-time platelet transfusion. Following initiation of steroids his platelets improved to 56 x10(9)/L on Day 2, 80 x10(9)/L on Day 3 and 148 x10(9)/L on Day 4. On further discussion he mentioned that one week prior to rash initiation, he switched to a new brand of synthetic CBD oil. Given the temporal relationship, this presentation was deemed to be drug induced ITP secondary to synthetic CBD oil use. He was recommended to stop using synthetic CBD oil. He was discharged home with a dose of 60 mg daily of prednisone with close follow up.
Discussion: CBD and tetrahydrocannabinol (THC) are the two common chemical compounds of cannabis. Some CBD compounds are synthetically derived in the laboratory and are not FDA approved, but still used for medicinal purposes. ITP is a diagnosis of exclusion and drug induced ITP secondary to synthetic CBD needs to be in the differential for thrombocytopenia. Only two case reports of ITP related to synthetic CBD use are noted in literature. In both these scenarios, ITP promptly responded to oral prednisone therapy. This could either be an uncommon clinical presentation or more likely an underdiagnosed clinical presentation as cannabinoid use history is not explicitly and accurately obtained by providers or voluntarily shared by patients. Management includes discontinuation of the synthetic CBD product and initiation of oral steroids. This case highlights the need for clinicians to consider synthetic CBD use as a differential for ITP. Given increased CBD use due to legalization, specific questioning about CBD use should be a routine similar to alcohol and tobacco use history. Reporting of these case scenarios will augment medical literature on the possible complications due to synthetic CBD use.
Conclusions: Synthetic CBD use can cause ITP. Recreational and medicinal CBD use needs to be elicited promptly in medical history. Management includes discontinuation of the CBD product and initiation of oral steroids.
To cite this abstract:
CHAVOUR, S; RIZVI, S; KRAUS, J; JOHNSON, J.
SEVERE IMMUNE THROMBOCYTOPENIC PURPURA SECONDARY TO SYNTHETIC CANNABINOID USE.